Provider Demographics
NPI:1033164629
Name:GIBSON, SCOTT C (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:C
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18-4 E DUNDEE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5277
Mailing Address - Country:US
Mailing Address - Phone:847-342-0400
Mailing Address - Fax:
Practice Address - Street 1:18-4 E DUNDEE RD STE 210
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5277
Practice Address - Country:US
Practice Address - Phone:847-342-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0089071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical